Browsing by Subject "Thrombosis"

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  • Mustanoja, Satu; Pekkola, Johanna (2016)
    Akuu­tin ai­vo­val­ti­mo­tu­kok­sen las­ki­mon­si­säis­tä liuo­tus­hoi­toa voi­daan an­taa nel­jän ja puo­len tun­nin ku­lues­sa oi­rei­den alus­ta. Hoi­to on aloi­tet­ta­va he­ti, kun vas­ta-ai­heet on pois­sul­jet­tu. Jos po­ti­laan ai­vo­ve­ren­kier­to­häi­riön oi­reet ovat vai­keat, ei suu­ren ai­vo­val­ti­mon tu­kok­sen las­ki­mon­si­säi­nen liuo­tus­hoi­to yleen­sä rii­tä. Sen li­säk­si har­ki­taan en­do­vas­ku­laa­ri­hoi­to­na lä­hin­nä me­kaa­nis­ta trom­bek­to­miaa kuu­den tun­nin ku­lues­sa. En­do­vas­ku­laa­ri­hoi­toa har­ki­taan myös sil­loin, kun las­ki­mon­si­säi­sel­le liuo­tus­hoi­dol­le on vas­ta-ai­he: INR-ar­vo yli 1,7 tai po­ti­las käyt­tää sään­nöl­li­ses­ti uut­ta ve­re­no­hen­nus­lää­ket­tä da­bi­gat­raa­nia, ri­va­rok­sa­baa­nia tai ­apik­sa­baa­nia. Pää­tös en­do­vas­ku­laa­ri­hoi­don aloit­ta­mi­ses­ta teh­dään ylio­pis­to­sai­raa­las­sa mo­niam­ma­til­li­ses­ti, ja toi­men­pi­teen ai­hees­ta päät­tää neu­ro­lo­gi yh­des­sä sen suo­rit­ta­van ra­dio­lo­gin kans­sa. Hoi­dos­ta on an­net­tu uu­si oh­jeis­tus, jo­ka kos­kee neu­ro­lo­gian päi­vys­tä­jien li­säk­si myös päi­vys­tyk­sen eri­koi­sa­laa, ku­ten kes­kus­sai­raa­la­ta­soi­sia päi­vys­tä­jiä. Päi­vys­tyk­sel­li­seen AVH-hoi­toon lä­het­tä­mi­sen kri­tee­rit säi­ly­vät en­nal­laan ja hoi­don va­lin­taan ote­taan kan­taa ylio­pis­to­sai­raa­loi­den päi­vys­tys­pis­teis­sä.
  • Haatainen, Hanna-Kaisa (Helsingin yliopisto, 2018)
    Hemostasis is a highly regulated process, which enables the repair of damaged blood vessels by clotting but also keeps the blood fluid and removes blood clots when they are no longer needed. There is a variety of medical conditions that could lead to hemostatic malfunction, manifesting in thrombosis and/or bleeding. The aim of this study was to get acquainted with these conditions and the fundamental laboratory methods for screening hemostasis. Another goal was to study APAC variants in these selected test methods. APACs are semisynthetic molecule complexes consisting of human serum albumin (HSA) core and tailored number of covalently bound UFH chains. In several animal models, APACs have established both antiplatelet (AP) and anticoagulant (AC) functions. They target and act locally at the vascular injury site. We used 7 APAC variants differing at their coupling level of UFH (CL). We chose test methods to assess the intrinsic and common coagulation pathways, the activity and concentration of thrombin in clotting plasma, interactions between different agents in coagulation and the ability of collagen to induce platelet activation and aggregation. The chosen methods were Activated Partial Thromboplastin Time (APTT), thrombin time, Rotational Tromboelastometry (ROTEM), the Calibrated Automated Thrombogram (CAT) and Collagen-induced Platelet Aggregation in Platelet-rich plasma (Aggregometer, AggRAM). Generally, all studied APAC variants show dose-dependent inhibition of coagulation that is at least similar, but mostly more efficient compared with plain UFH. At the concentration corresponding to clinically relevant heparin concentration (3 µg/ml), APACs prolong the coagulation globally. At low concentrations they are more potent anticoagulants and thrombin inhibitors than UFH and also inhibit platelet procoagulant activity (PCA). Further studies are needed, however, the results support data that APACs are promising targets for the future drug development.
  • Sivula, Mirka; Lassila, Riitta (2020)
  • Korkama, Eva-Stina; Jarva, Hanna; Lehto, Minna; Pelliniemi, Tarja-Terttu; Poikonen, Eira; Salonen, Jonna; Sinisalo, Marjatta; Säily, Marjaana; Meri, Seppo; Armstrong, Elina (2017)
  • Lönnqvist, Lasse; Laitinen, Mika (2020)
    Positiivisen COVID-19-testituloksen saanut nuori mies otettiin oireiden vaikeuduttua sairaalaan osasto¬seurantaan. Vointi koheni ja hänet kotiutettiin, -mutta kotona oireet palasivat ja yleistila heikkeni.
  • Marbacher, Serge; Niemelä, Mika; Hernesniemi, Juha; Frösen, Juhana (2019)
    Although endovascular therapy has been proven safe and has become in many centers the primary method of treatment for intracranial aneurysms, the long-term durability of endovascular embolization remains a concern; at least for some aneurysms despite initial good result. While healing after clipping relies on mechanical occlusion, restoration after endovascular occlusion mainly requires the induction of a biological response. Healing after embolization depends on the growth of new tissue over the thrombus formed by the embolization material, or alternatively, on the organization of thrombus into fibrous tissue. This review highlights the fundamental importance of aneurysm wall biology on the healing process and long-term occlusion after intracranial aneurysm (IA) treatment. It seems likely that the effect of luminal thrombus on the IA wall, as well as the IA wall condition at the time of thrombosis, determine if thrombus organizes into scar tissue (neointima formation by infiltration of cells originating from the IA wall) or if the wall undergoes continuous remodeling, which is primarily destructive (loss of mural cells). In the latter, intraluminal thrombus organization fails and the impaired healing increases the chance of recurrence. Mechanisms underlying IA reopening, the influence of intraluminal thrombosis on the IA wall, and clinical implications of the IA wall condition are discussed in detail, along with how knowledge of IA wall biology can offer new solutions for IA treatment and affect the patient selection for and follow-up after endovascular treatment.
  • Tulamo, Riikka; Mäyränpää, Mikko I.; Aho, Pekka (2019)
  • Laivuori, Christa; Sandelin, Henrik; Virtanen, Kaisa; Ikonen, Anna; Pyhältö, Tuomo (2020)
    Tylpät kaulasuonivammat ovat harvinaisia, mutta todennäköisesti alidiagnosoituja. Ne ovat yleensä suuren vammaenergian aiheuttamia. Oireet johtuvat iskeemisistä aivotapahtumista ja voivat vakavuudeltaan vaihdella huomattavasti sekavuudesta halvausoireisiin. Kaulasuonivamma ja verenvuoto voivat myös aiheuttaa painetta ympäröiviin kudoksiin ja ahtauttaa hengitysteitä. Diagnoosi tehdään kaulavaltimoiden TT-angiografialla. Hoidossa pyritään ehkäisemään verisuonen hyytyminen umpeen ja embolioiden muodostuminen. Endovaskulaarisiin tai avotoimenpiteisiin päädytään hyvin harvoin.